FINDINGS:At the time of surgery revealed audible lysis of adhesions.
Upon manipulation and extensive capsular inflammation and impingement
with rotator interval contracture and contracture within the joint,
for which decompression, manipulation, release, and extensive
debridement were performed.

PROCEDURE:The patient was brought to the operating room. General anesthesia was induced. The patient was then manipulated under anesthesia with traction and flexion. We had audible lysis of adhesions and overhead obtained 180 degrees of elevation. The arm was held in the supracondylar area for external rotation at the side, as well as internal and external rotation at 90 degrees of abduction. The patient was placed in a beachchair position. The left arm was draped and prepped in the usual sterile manner. IV antibiotics were administered. Standard posterior portal was used, the blunt trocar into the joint, and organized inspection of the joint revealed severe scarring of the rotator interval and synovitis within the joint. An anterior portal was placed and through this portal, we used a thermal electro wand to perform a capsular release. We released the entire rotator interval and extended this continually down anteriorly and inferiorly until we had circumferentially released the shoulder and obtained hemostasis. The rotator cuff was found to be intact. We then again manipulated the shoulder to obtain full elevation, external rotation of 80 and internal rotation to T8. I then brought the arthroscope up into the subacromial space, where we identified significant fibrosis and scarring consistent with impingement and contracture. We placed a third portal anterolaterally and through this portal, we performed extensive debridement of very inflamed bursa and fibrosis. This was quite extensive into the lateral gutter. We used the thermal electro wand and meniscal shaver. We released the soft tissue from the undersurface of the acromion, released the coracoacromial ligament, and identified a very narrowed subacromial space. A 6.0 acromionizer was then used from medial-to-lateral and anterior-to-posterior to release and decompress the subacromial space and perform a subacromial decompression transforming this into a flat type I acromion without further impingement on the rotator cuff beneath it. We copiously irrigated. Obtained hemostasis. We brought the arthroscope into the anterolateral portal and confirmed from medial-to-lateral and anterior-to-posterior. The acromion was flat without impingement on the cuff. The cuff was intact. We copiously irrigated and continued with an extensive debridement until we had excellent mobility as well as visualization...

Can someone help w/determining if 29825 can be reported?

You'll lose the 23700 (Manipulation) as this is always included with any surgical procedure. I did not really see 29823. The debridement (bursa + fibrosis) would bundle with the 29826 as a bursectomy is part of a decompression 29826. The capsular release could be captured with either 29825 or 29823. Since you have 29823 already reimbursed you'll have a very difficult time getting 29825 paid as well. Hope this helps..

You'll lose the 23700 (Manipulation) as this is always included with any surgical procedure. I did not really see 29823. The debridement (bursa + fibrosis) would bundle with the 29826 as a bursectomy is part of a decompression 29826. The capsular release could be captured with either 29825 or 29823. Since you have 29823 already reimbursed you'll have a very difficult time getting 29825 paid as well. Hope this helps..

"we performed extensive debridement of very inflamed bursa and fibrosis. This was quite extensive into the lateral gutter."

Not too sure, I didn't code this report.

Usually an extensive debridement will capture multiple soft tissues but the bursectomy is inclusive in 29826 as would the fibrosis (same compartment). I still only see 29826 and 29823 as the 29823 would capture the capsular release

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